It is generally desirable to minimize the invasiveness of medical procedures, including therapeutic or diagnostic procedures. Invasive “open” medical procedures are generally more expensive than minimally invasive “keyhole” procedures, and there is often a greater risk of complication and discomfort for the patient. Since open surgery typically requires relatively large incisions, blood loss can be high and the risk of infection or other post-operative complications may increase. Large incisions may require extended recovery times to heal and leave unsightly scarring. Accordingly, methods, systems, and devices that reduce trauma to the patient, are less invasive, or enhance recovery are desirable.
Numerous minimally invasive procedures have been developed, including some that use laparoscopic devices. However, laparoscopic devices are rigid and must be pivoted about the incision through which they are passed. Precise control of the distal end of a rigid laparoscopic device can be difficult due to this pivoting movement. Visualization may also be complicated because a separate optical device is required. In addition to requiring an extra incision, the optical device must be appropriately positioned to provide a useful field of view of the surgical site. Maintaining or adjusting the optical device relative to the laparoscopic device is time consuming and may involve constant attention, especially if the surgical site is moved during the procedure. Moreover, controlling the ends of multiple laparoscopic devices based on a point of view well proximal to the surgical site is complicated, requires extensive training, and may result in unwanted trauma to surrounding tissue. Robotic systems that use rigid instruments suffer similar disadvantages.
One region that is particularly difficult to access using standard rigid laparoscopic devices is the mediastinum. Thoracic access is limited by the surrounding ribs and sternum, and abdominal access places the incision at considerable distance from the desired surgical site. Abdominal laparoscopic access to mediastinal tissue poses significant ergonomic challenges, including working in small spaces with insufficient triangulation or visualization. Dissection around the hilum of the lung is essentially performed blind, which may affect oncologic resection or long term prognosis. Inadvertent injuries to the surrounding vital structures may also result. The difficulties associated with mediastinal access have hindered the development of esophagectomy procedures using laparoscopic devices.
Standard endoscopic devices are also unsuitable for accessing the mediastinum or performing esophagectomies because, in part, because the approach is not through a natural body cavity. Standard endoscopes are specifically designed to flex to pass through the lower gastrointestinal tract or the esophagus. Consequently, they are not configured for use in procedures requiring navigation past organs or through tissue without surrounding support structure to guide them. Standard endoscopic devices are too long or too flexible for such navigation. In addition, these devices are not configured for ergonomic control of instruments passed through them. Control of a standard endoscopic device often requires two hands to operate, meaning that only one device can be operated at a time by a surgeon. Nor can standard endoscopic devices be locked or moved incrementally relative to a patient. The present disclosure overcomes at least some of the limitations of prior art.
It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the invention.